Helping Your Client Technically Qualify for SSDI and SSI

If you have a client with a disability or mental illness, he or she may want to apply for Social Security disability benefits. Before your client can be approved for disability benefits, the Social Security Administration (SSA) must verify your clients meets both the medical and technical eligibility requirements for disability benefits. Medical qualification is the same for both of the SSA’s disability programs, but technical eligibility rules differ.

Social Security Disability Insurance (SSDI)

SSDI is an “insurance” program that provides coverage for disabled workers. To qualify, your client must have:

  • paid into the Social Security system either through FICA or self-employment taxes
  • worked within the last 10 years
  • between 20 and 40 work credits available at the time of disability onset, although this will be even lower for younger applicants. The SSA does not expect a 21 year old to have worked as much as a 60 year-old applicant.

Work credits accumulate at a rate of about four per year for most workers. These credits build up as you pay employment taxes. Employment taxes may be either:

  • withheld automatically from a paycheck by an employer under the FICA tax code

OR

  • submitted to the IRS by self-employed persons as part of their self-employment taxes.

In either instance, employment taxes fund Social Security and Medicare. The taxes your client paid over your employment history make her a “covered person” under both of these insurance programs.

Supplemental Security Income (SSI)

SSI is a need-based program available to disabled persons of all ages and the elderly. There are no work credit requirements to qualify, but there are strict financial eligibility rules. To receive SSI, your client must meet the income and other financial resource limits.

When determining eligibility, the SSA specifically reviews your client’s:

  • earned and unearned income,
  • other benefits, like retirement or VA benefits,
  • money from other sources, like assistance from friends or family,
  • free food, housing, or other donated or gifted resources,

AND

  • any financial assets or other resources you have that could be converted to cash, like life insurance policies, savings bonds, and bank accounts, among others.

Although the SSA requires your client to disclose information about all of your finances, certain income sources and other financial resources are excluded from consideration. These include:

  • a percentage of earned income each month,
  • benefits you get through other need-based programs, like SNAP or TANF,

AND

  • one vehicle and your primary residence, if your clients owns his or her own house.

Financial resources from all countable sources cannot exceed the SSA’s established income and asset limit. This limit is reviewed and adjusted each year when cost-of-living increases go into effect. For 2016, the limit is $2,000 per month for an individual or $3,000 per month for a married couple in which both spouses receive SSI.

Applying for Benefits

If your client has worked enough to qualify for SSDI, or has income low enough for SSI, he or she can start the application process. Whether applying for SSDI, SSI, or both, your client can use the SSA’s online application portal, which allows applicants to fill out and submit all the required forms for an SSDI claim. The SSA can additionally use your client’s online application to start an SSI claim.

Some applicants choose instead to apply for SSDI at their local office. The SSA requires a personal interview to complete any SSI application, so your client may need to make a trip to the local office anyway.

When your client is applying for Social Security disability benefits, be sure to submit a letter outlining how your client’s illness keeps him or her from working. A social worker’s opinion and expertise can go a long way in helping your client win Social Security disability benefits.

When Basic Living is Considered a Utopia for the Poor

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With our fast paced lives in a technological age of instant gratification and easy distraction, it’s no wonder news channels are beginning to advertise “distractify” sections on their web pages. It’s not difficult to see how quiet unassuming people may get pushed aside, and their needs relegated to the back burner. We assume that they’ll get social security which will provide some basic living. After all, we are told that all Americans can get social security once they retire. Right?

But, retiring means that you have worked, and social security is based on earnings over your lifetime. For homemakers, this doesn’t help much. We assume that they’ll receive Medicare, and yes we might even hear about the problems and costs associated with what Medicare doesn’t cover. We might even assume that the elderly will get food stamps without realizing just how meager food stamp grants really are. In an age of cuts to social programs, not only are all of these so-called entitlements at risk, programs such as food banks, meals on wheels, and utility assistance are also at risks which leads me to tell you about Mrs. Jones.

Mrs. Jones* is a vibrant and lovely elderly woman, free with stories of years gone by and quick with an ear for friends and neighbors. She loves working in her garden and sitting on her porch chatting with passers-by. Many in her community in Atlanta look forward to the spritely older woman and her tales. Many more loved her homespun wisdom and down home recipes, both of which she’s quick to share.

So, it was with great shock and profound sadness that the community witnessed its first day without the fixture that was Mrs. Jones and the loss was palpable. The shock and sadness only increased as the story behind Mrs. Jones’ absence spread.

In all the time she was cornerstone of the community, the very bedrock that most communities seek to cultivate, no one guessed she might have a secret. Mrs. Jones was used to being relied upon in her community and never thought to ask for anything in return. While her neighbors were friendly, caring, and even supportive of her, no one thought to inquire into how this lovely elderly woman, a widow who’d largely been a homemaker, was fairing. Sadly though, Mrs. Jones is one of countless citizens in an unenviable position. She is one of the 3.4 million citizens aged 65 and over in our country who live in poverty making her part of an extremely vulnerable population and one that is often forgotten in our society.

As a widow she did qualify for survivor’s benefits, but as someone who was largely a homemaker, her social security was meager at best. She did happen to qualify for Medicare, but was judged to be over the resource limit for food stamps. Living alone without dependent children reduced her benefits limit to the point that she was deemed to make too much. In short, after a lifetime of raising children, keeping house, and being a good and supportive wife to her husband all things lauded as family values to be protected, the system failed Mrs. Jones.

On the night where we pick up Mrs. Jones’ story, the night before her community witnessed the absence of its cornerstone, Mrs. Jones dialed 911 in a panic. She was having incapacitating abdominal cramps coupled with vomiting. When she arrived at the emergency room she was quickly diagnosed with a bowel obstruction and raced into emergency surgery. Afterward she was admitted to the ICU to recover from surgery and to stabilize her condition. A few days after she was admitted, a concerned friend came to visit and that’s when the true tragedy of Mrs. Jones case was revealed.

Her neighbor, perhaps one of her closest friends, knew that Mrs. Jones had been diagnosed with a heart condition, and that the treatment course was not covered by her insurance. This is not uncommon among the elderly who frequently have too many medical bills and not enough money or insurance. Many Americans think that supplemental insurance like Medicare part D picks up the rest, but the truth is it doesn’t cover everything and creates what some call the Medicare donut. In this position, Mrs. Jones was left to decide between medication and other necessities like food, which also is not uncommon among the elderly.

What makes this story less common, but by no means unheard of, is how Mrs. Jones decided to solve the problem. With too many financial needs and too few dollars at her command, Mrs. Jones decided that she would have to resort to eating dog food to afford her medications. That’s right, as she was trading recipes with her neighbors, offering an ear to all and being the foundation of her community, Mrs. Jones had resorted to eating dog food.

Mrs. Jones had been failed by the very society of whom she was a bedrock. Even more tragically, she is now saddled with even more medical debt which lead to her illness in the first place. Only time will tell how Mrs. Jones’ story will end. With her grown children having moved away and her husband  now deceased, it is very likely her community will forever lose its cornerstone. The debt she’s incurred will drive her to even more austere measures and ultimately lead to her being placed in assisted living.

Mrs. Jones’ story and the stories of millions like her doesn’t have to end this way. It doesn’t have to be a story of poverty, increased health care costs, and increased demand for limited assisted living spaces. The only solution that eliminates poverty and corrects societal tragedies like Mrs. Jones story is a universal basic income.

Had Mrs. Jones lived in a country that provided a guaranteed basic income for its citizens, Mrs. Jones would not live in poverty. She’d receive a stipend that guaranties her a comfortable existence where she could afford food and adequate health insurance. Insurance where her medication is covered, thus eliminating the strain of poverty on our health care system.

Clearly our current system, which leaves 3.4 million of our elderly in poverty, estimates as many as 44% of seniors would be living in poverty if it were not for social security. As stated in the findings by Center for American Progress, the system is broken, and it’s time to find a solution. 

Editors Note: *Mrs. Jones and staff at Emory University Hospital spoke to me on condition of anonymity. Mrs. Jones name was changed to protect her privacy.

Blue Cross Report: Social Services Critical to Improving Health

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In a new report by the Blue Cross Blue Shield Foundation, social, behavioral, and environmental factors are shown to determine a staggering 60% of one’s overall health. The report provides overwhelming support for increased investment in, and collaboration with, social services as a way of improving overall individual and community health.

The report’s key findings include:

-Providing housing support for low-income, high-need individuals can result in net savings due to reduced health care costs. The net savings range from $9,000 per person per year to nearly $30,000 per person per year for the Housing First model, a harm-reduction approach in which adults who are homeless and who have behavioral health conditions are provided supportive housing.

-Nutritional assistance for high-risk women, infants, and children as well as older adults and people with disabilities lowers infant mortality rates, improves birth weights, reduces nursing home admissions, and significantly lowers federal and state Medicaid costs.

-Vulnerable populations experience health gains when their care is coordinated across primary, specialty, behavioral, and social services and that hospitalizations and emergency department visits are demonstrably reduced.

-Partnerships between health care and social service providers, particularly housing service providers, have been effective in improving health outcomes in certain high-need populations.

-Income support programs, specifically the Earned Income Tax Credit (EITC) and Supplemental Security Income (SSI), were associated with better health outcomes for those individuals who qualify for such programs.

By attributing 60% of one’s health to social, behavioral, and environmental factors, Blue Cross Blue Shield is making known that social workers and social service programs are the key to improving the health of individuals and communities. The report opens the door for unprecedented collaboration between social workers and private sector health insurers, who can work together to address patient care as a whole unit.

The report adds to the increasing evidence that integrated healthcare is the future of care delivery. Integrated care involves primary care providers and behavioral/mental health providers working in unison to treat the whole patient. Social workers, who are trained in interdisciplinary collaboration, are uniquely qualified to serve in this capacity.

Most importantly, the message of the report is clear: achieving optimal health is impossible without increased investment in social service programs, especially for vulnerable populations. This provides a major opportunity to advocate on behalf of increased investment in programs that improve health while reducing healthcare costs. When one of the nation’s largest health insurers says that social service programs are critical to the health of our nation, policy makers will have to listen.

The Need for Congress to Pass the ABLE Act

by Vilissa K. Thompson, LMSW

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The ABLE Act has the potential to improve the financial and employability statuses of people with disabilities in this country, if enacted.  The Achieve a Better Life Experience (ABLE) Act gained the attention of the disability community when it was first introduced into Congress on February 13, 2013.  The ABLE Act was not decided on last year due to the fact that the Congressional session ended before the bill could be considered; however, it has the support of over 400 co-sponsors in the House and Senate.  Having such a large amount of support gives many disability advocates, including yours truly, great hope that the Act will be considered and passed this year.

The purpose of the ABLE Act is to prevent disabled savers from losing their benefits by affording them the opportunity to open special tax advantaged saving accounts.  Under current policy, those who receive social security benefits such as Supplemental Security Income (SSI) and Medicaid cannot have saving assets of more than $2,000 in an account, and cannot earn income over $700 a month.  Those two financial restrictions unfairly places beneficiaries in the proverbial “a rock and a hard place.”  If beneficiaries have assets or income that exceed these financial thresholds, their benefits will be cut off.  If they decide not exceed these financial thresholds, then their employment and independence opportunities will be severely reduced.

I will give you a fictional example of the “rock and a hard place” choices people with disabilities like myself endure when it comes to wanting to be independent, but fear losing one’s benefits:

“Anita” was offered a part-time telecommuting position that would pay her the current minimum wage rate of $7.25 an hour.  Anita currently receives SSI and Medicaid benefits because she has a physical disability.  In order to keep her benefits, Anita could only work 24 hours a week, which would total $174 a week of earned income for her.  With this weekly schedule, Anita would earn $696 a month before taxes, which would put her under the $700 monthly financial threshold amount by $4.  

Anita would have to report her new income source to the Social Security Administration (SSA), which would take into consideration her total earnings, and not the amount Anita actually brings home after taxes.  The SSA has a special mathematical formula it utilizes to figure how much of Anita’s earned income should be counted against her benefits.  Anita’s monthly wage before taxes was $696; SSA would subtract 85 from this amount, and then divide that amount by 2 to figure how much her SSI benefits for that month should be reduced.  So, $696 – 85 would equal $611.  $611 divided by 2 would be $305.50.  Social Security would count $305.50 against Anita benefits, which would reduce her SSI benefits amount from $721 a month to $415.50 a month.  (The 2014 cost of living adjustment (COLA) for SSI beneficiaries is $721.)

This gross reduction of SSI does nothing to elevate Anita out of poverty.  Anita would have only $1,111.50 ($415.50 in reduced SSI, and the $696 (before taxes) she earned from working) to live off each month, which is not enough to cover the basic human needs of food, housing, and clothing.  This example is not hypothetical; it is fact.  This is the dreadful choice people with disabilities have to make:  do I work and put my benefits in jeopardy, or do I live off $721 a month that will keep me deep in poverty, and not allow me to be able to afford housing, transportation, entertainment, have an emergency fund, “nest egg” savings, and other “luxuries” that most take for granted?

This is why the passage of the ABLE Act is imperative – it would extinguish the current barrier of working and saving by ensuring that money saved through ABLE accounts would not be counted against the federal benefits an individual receives.  The ABLE Act would ease financial strains by allowing the tax-free saving accounts to cover qualified, essential expenses such as medical and dental care, community based supports, employment training, assistive technology, housing, education, and transportation.

The bill would assist in supplementing the benefits they already receive from private insurances, Medicaid, SSI, their employment, and other sources.  An ABLE account would provide people with disabilities the same types of flexible saving tools that other Americans have through college savings accounts, health savings accounts, and individual retirement accounts (IRAs).  Returning to our example, if the ABLE Act passed, Anita would be able to open an ABLE account where she could deposit her earned income and keep her SSI and Medicaid benefits intact.  This newfound freedom would allow people with disabilities to work without the fear of being penalized.

Like millions of Americans with disabilities, I am anxiously waiting for the passage of the ABLE Act.  From a personal standpoint, the ABLE Act would open a plethora of doors for me as an entrepreneur and a freelance writer.  Not having to worry about how much I earn or how much I have saved would be a joyous moment.  People with disabilities want the same things as everyone else – to work, have healthcare coverage, and be able to living independently and support themselves and those they love.  The ABLE Act would turn those hopes into reality.  Please urge your federal representatives to support and pass the ABLE Act this year because it is long overdue.

(Featured headlining image:  Courtesy of The Denver Channel.)

Long Term Disability: Understanding the Process

Seal of the United States Social Security Administration. It appears on Social Security cards. (Photo credit: Wikipedia)

Disability rulings are commonly issued by the Social Security Administration, although reaching a decision on what qualifies a person as disabled can be a long and frustrating experience.

According to socialsecurity.gov, “Disability is a subject you may…not think of as something that might actually happen to you. But your chances of becoming disabled are probably greater than you realize. Studies show that just over 1 in 4 of today’s youth will become disabled before reaching age 67.

What many applicants do not understand is that receipt of monthly disability payments is the second part of the application process. The first step in a Social Security case settlement is declaring the recipient legally disabled.

A disability ruling can do several things. As an example, it can render a disabled individual unemployable if the state only has one workers compensation insurance company, and the company refuses to qualify the claimant for workers comp coverage. It is a legal ruling in every sense of the term, which, if you are a New York resident, can be better understood via the services of an attorneys office such as the  The Perecman Firm which was voted as a “best lawyer” by U.S. News.

Supplemental Security Income

Some individuals are only eligible for Supplemental Security Income (SSI), which is awarded yearly based on personal financial assets and disability level. These recipients are usually not of age for standard Social Security Disability Insurance (SSDI). SSDI payments are based on the tax receipts from the claimant during their working career. SSI is awarded for serious medical conditions that will last for at least one year in which the recipient is receiving ongoing medical treatment. With “serious” being the operative word, SSI is often temporary, based on medical improvement. Older recipients are rarely re-evaluated, so this can amount to a permanent disability ruling for these individuals. Younger SSI recipients are encouraged to return to work through the Ticket to Work Program.

Social Security Disability Insurance

Social Security Disability Insurance differs greatly from Supplemental Security Income. SSDI claim approvals are permanent and total in nature, although disabled recipients can earn a nominal amount of money through part-time employment. Benefit amounts are determined by the tax receipts over the immediate previous ten-year employment span, with the applicant needing at least five complete years worked. This amounts to 20 credits of three-month employment deduction periods to qualify. Once the disability ruling is issued, the claimant will receive federal disability benefits for the remainder of their life.

Supplemental Security Income Funding

Supplemental Security Income is funded by Congress in the national operational budget that is normally issued every two years. The cost of the program has been the subject of much ridicule, but the program provides crucial medical benefits for disabled individuals who are in seriously declining health, many of which are in professional medical care facilities and hospitals. Both the monthly income benefit program and the medical funding for the program are included in the same action of funding.

Social Security Disability Funding

The Social Security Administration system was established with a trust fund that was used to pay recipients who have earned the benefit through tax deductions for program eligibility. However, individuals who become disabled before age 67 can petition the Social Security Administration for the disability ruling, which in turn makes the claimant eligible for monthly payments until death. In addition, disabled recipients dram an extra benefit allowance, so the disability ruling is worth more money.

Most beneficiaries attempt to win a disability ruling instead of waiting for standard Social Security retirement benefits. This situation clearly puts stress on the funding mechanism, which is determined by estimating the percentage of total tax receipts which are Social Security tax deductions and listed as an asset on the balance sheet. However, they are still a liability because the Social Security Trust Fund established in the 1940s was drained by Congress in 1987 and applied to the general fund.

This makes the Social Security program the largest reported expenditure of the government with no repayment of the transferred loans from the now-vacant trust fund, which is the primary reason Congress is highly concerned about the future viability of the program. This is also part and parcel to the absolute need for a Social Security Disability attorney like those at The Perecman Firm to represent these cases which often take years to settle because of funding problems.  When looking for an attorney in your area, us an accredited sites such as the U.S. News – Best Lawyers where “Best Law Firms” rankings are based on a rigorous evaluation process to find representation may be a wise choice.

Disability Claim Approved! Winning the Appeals Process for SSI

Social Security Administration
Social Security Administration

Most anyone who has gone through the Social Security or SSI disability system finds out how challenging it is, since most claims are denied the first time out. The chances of approval do go up substantially for those who appeal and have a disability lawyer to guide them through the process. Below is some information about the appeals and hearing process for disability claims.

Appeals Process

The appeals process for Social Security disability and SSI includes several levels. After the first round when the claim is denied, most states offer a chance at what is termed reconsideration. This must be requested formally within sixty days of the denial date. Because the process is complex, it is highly advisable to enlist the services of an experienced disability denial lawyer. Found online at www.disabilitydenials.com, a person can read more about what is needed for an experienced legal professional to help claimants prepare for and manage the appeals process.

Appeals Preparation

The most important thing to recognize with disability claims is that the decisions will be made based upon the information that has been provided. Therefore, claimants need to know what is in the file and have their own copies available. This is where having a lawyer on the case is very beneficial, since they know how the law works and what is necessary to establish and win the claim.

In order to respond to requests, claimants must understand their medical condition, what it entails and what doctors have reported. There is also a detailed work history and other data that Social Security and any disability claim will require. For instance, claimants must have this information at hand so that when it is requested it can be provided correctly. Otherwise, claims could drag out much longer than they need to or even continue to be denied.

Winning Disability Awards

1. Medical Records – One of the more important types of information that needs to be available are updated medical records. Hearings may take place a year or more after an initial claim is made and SSA may cease to gather medical evidence. Therefore, the file may not include the latest medical information. A disability lawyer representing the claim would be handling these tasks, which is another reason to enlist their services. In any case, claimants must gather all their medical updates and keep them handy to respond to SSA requests and be prepared for hearings.

2. Personal Records – The SSA will continue to request information about the disabling condition both in writing and at hearings. Therefore, claimants must keep good notes about how they feel and what they are able to do and not do. For instance, any activities that could be done prior and cannot since the condition should be noted. The precise reasons that a claimant is unable to perform their customary work-related responsibilities needs to be detailed so that when asked, the information is conveyed correctly to the administrative law judge (ALJ). Otherwise, decisions rendered without all of the pertinent information usually result in further claim denials.

Hearings

After the first appeal is denied, claimants may request a hearing before an ALJ. The best way to win any appeal is to understand the process so that it may be navigated more efficiently. The average time that Social Security Disability Insurance (SSDI) claimants wait for a hearing is around 400 days and as long as a year or more.

Statistically, the chances of winning any disability case are much higher when the claimant has engaged an attorney experienced in disability law. In these cases, attorneys usually do not charge fees until the claim is won, in accordance with the law. In fact, without an experienced disability lawyer, there is a very strong chance that the case will be denied repeatedly. As suggested online at www.disabilitydenials.com, anyone filing for Social Security Disability should seek counsel as soon as possible to greatly increase their chances of winning disability claims.

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